Complementary feeding diets in low‐ and middle‐income countries are generally inadequate to meet requirements for growth and development. Food‐based interventions may prevent nutrient inadequacies ...provided that they do not displace other nutrient‐rich foods. We conducted a randomized controlled trial in rural Malawi in which 660 children aged 6 to 9 months were provided an egg a day for 6 months or assigned to a control group. Dietary intake of complementary foods and drinks was assessed at baseline, 3‐month midline and 6‐month endline visits using a tablet‐based multipass 24‐h recall. Up to two repeat recalls were collected at each time point in a subsample of 100 children per treatment group. At midline and endline, usual energy intake from eggs was about 30 kcal/day higher in the egg group compared with controls (p < 0.0001). Compared with controls, children in the egg group were over nine times more likely to consume eggs at midline and endline. There was a comparable, but nonsignificant, greater total usual energy intake from complementary foods of 30 kcal/day at midline (p = 0.128) and 36 kcal/day at endline (p = 0.087). There also was a displacement of 7 kcal/day in legumes and nuts in children at endline (p = 0.059). At midline and endline, more than 80% of children in the egg group consumed a minimally diverse diet compared with 53% at midline and 60% at endline in the control group. This study illustrates that mothers in the egg group fed eggs to young children on a regular basis without substantial displacement of other complementary foods.
Background:
Detailed dietary intake data in low-income populations are needed for research and program evaluation. However, collection of such data by paper-based 24-hour recall imposes substantial ...demands for staff time and expertise, training, materials, and data entry.
Objective:
To describe our development and use of a tablet-based 24-hour recall tool for conducting dietary intake surveys in remote settings.
Methods:
We designed a 24-hour recall tool using Open Data Kit software on an Android tablet platform. The tool contains a list of local foods, questions on portion size, cooking method, ingredients, and food source and prompts to guide interviewers. We used this tool to interview caregivers on dietary intakes of children participating in an efficacy trial of provitamin A-biofortified maize conducted in Mkushi, a rural district in central Zambia. Participants were children aged 4 to 8 years not yet enrolled in school (n = 938). Dietary intake data were converted to nutrient intakes using local food composition and recipe tables.
Results:
We developed a tablet-based 24-hour recall tool and used it to collect dietary data among 928 children. The majority of foods consumed were maize, leafy vegetable, or small fish dishes. Median daily energy intake was 6416 kJ (1469 kcal).
Conclusions:
Food and nutrient intakes assessed using the tablet-based tool were consistent with those reported in prior research. The tool was easily used by interviewers without prior nutrition training or computing experience. Challenges remain to improve programming, but the tool is an innovation that enables efficient collection of 24-hour recall data in remote settings.
Eggs are a rich source of choline, an essential nutrient important for child growth and development. In a randomized trial of 1 egg/d in young children in Ecuador, an egg intervention led to ...significant improvements in growth, which were partially mediated by increased plasma choline concentration. A similar trial in Malawi (clinicaltrials.gov: NCT03385252) found little improvement in child growth or development.
We aimed to evaluate the effect of 1 egg/d for 6 mo on plasma choline concentrations in Malawian children enrolled in a randomized trial.
Infants aged 6–9 mo in rural Malawi were randomly assigned to receive 1 egg/d (n = 331) or serve as a nonintervention control (n = 329) for 6 mo. Anthropometric, developmental, and dietary data were collected at baseline and 6-mo follow-up, along with a blood draw. Plasma choline, betaine, dimethylglycine, trimethylamine N-oxide (TMAO), and DHA were measured at both time points using ultrahigh performance liquid chromatography–tandem MS (n = 200 per group). Linear regression analysis was used to determine the difference in plasma choline and related metabolites between groups after 6 mo of intervention.
Plasma choline, betaine, dimethylglycine, and DHA concentrations did not differ between groups at 6-mo follow-up. Plasma TMAO was significantly (26%; 95% CI: 7%, 48%) higher in the egg intervention group in a fully adjusted model.
Provision of 1 egg/d for 6 mo did not result in increases in plasma choline or related metabolites, except TMAO. This could partially explain the lack of effect on growth and development. Additional interventions are needed to improve choline status, growth, and development in this population.
Provision of 1 egg/d for 6 mo did not result in increases in plasma choline or related metabolites, except TMAO, in this randomized trial of young Malawian children.
Vitamin A deficiency (VAD) is common in populations with limited dietary diversity and access to vitamin A-rich foods.
This analysis aimed to determine the impact of supplementing children’s diets ...with 1 egg/d on the concentration of plasma retinol and RBP and the prevalence of VAD.
Children age 6–9 mo living in the Mangochi district of Malawi were individually randomly assigned to receive 1 egg/d for 6 mo (n = 331) or continue their usual diet (n = 329) in the Mazira trial (clinicaltrials.gov; NCT03385252). This secondary analysis measured plasma retinol by HPLC and RBP, CRP, and α-1-acid glycoprotein (AGP) by ELISA techniques at enrollment and 6 mo follow-up. Retinol and RBP were adjusted for inflammation, and mean concentrations were compared between groups using linear regression models. In addition, prevalence ratios of VAD (retinol <0.7 μmol/L) were compared between groups using log-binomial or modified Poisson regression models.
After 6 mo of study participation, 489 were assessed for retinol (egg: n = 238; control: n = 251), and 575 (egg: n = 281; control: n = 294) were assessed for RBP. Prevalence of inflammation (CRP >5 mg/L or AGP >1 g/L: 62%) and inflammation-adjusted VAD (7%) at enrollment did not differ between groups. At follow-up, the egg intervention group did not differ from the control in inflammation-adjusted retinol geometric mean (95% CI); egg: 1.10 μmol/L (1.07, 1.13); control: 1.08 (1.05, 1.12), RBP egg: 0.99 μmol/L (0.96, 1.02); control: 0.97 (0.94, 1.00), or prevalence of VAD egg: 6%; control: 3%; prevalence ratio: 1.87 (0.83, 4.24).
Provision of 1 egg/d did not impact VAD, plasma retinol, or RBP among young children in rural Malawi, where the prevalence of VAD was low. Curr Dev Nutr 2023;x:xx.
This trial was registered at clinicaltrials.gov as NCT03385252.
Abstract only
In resource‐limited settings, we generally assume that household food insecurity (HFI) status is static over time, ranging from a period of a few months to a few years. Longitudinal HFI ...measures are required to test the validity of this assumption. We assessed HFI on a monthly basis in the context of an efficacy trial of biofortified maize conducted in rural Zambia from October 2012 to March 2013. This period is mostly characterized as the lean season, which peaks in ~April in this setting. The trial included two intervention arms and a parallel non‐intervened group for the purposes of background dietary and food security measures. A total of 907 households were enrolled at baseline; however, the present analysis includes longitudinal data from 157 households in the non‐intervened arm. At each of the six monthly visits, HFI was assessed using a validated 8‐item perception‐based Likert scale with a one month recall period. We calculated a HFI index by summing scores over the Likert scale (ranging from 0 to 32). The median (IQR) HFI index was 7 (4–11), 8 (5–11), 7 (4–10), 6 (4–9), 6 (4–9) and 7 (4–9) at the six monthly visits, respectively. The correlation between HFI index between visits ranged from 0.3 to 0.4. A random effect model was fit on the index as a function of visit clustered at household level. Results from the model showed that the HFI index decreased on average by 0.25 points per visit. Within and between household variation in the index was 10.6 and 8.8, respectively. Within‐household variability of the HFI index did not show a clear pattern in relation to the household mean score. Because our repeated HFI measurements were conducted in one single season, the small change in mean monthly HFI index suggested that seasonal assessments may be sufficient for population monitoring purposes in similar settings. However, higher variation within some households suggests that household characteristics—as opposed to seasonal impacts on food security—may explain the differences in variation in response to the repeated scale.
Support or Funding Information
HarvestPlus (grant 8251) and Sight and Life Global Nutrition Research Institute at Johns Hopkins University
Background: Eggs are a rich source of choline, an essential nutrient important for child growth and development. In a randomized trial of 1 egg/d in young children in Ecuador, an egg intervention led ...to significant improvements in growth, which were partially mediated by increased plasma choline concentration. A similar trial in Malawi (clinicaltrials.gov: NCT03385252) found little improvement in child growth or development. Objectives: We aimed to evaluate the effect of 1 egg/d for 6 mo on plasma choline concentrations in Malawian children enrolled in a randomized trial. Methods: Infants aged 6-9 mo in rural Malawi were randomly assigned to receive 1 egg/d (n = 331) or serve as a nonintervention control (n = 329) for 6 mo. Anthropometric, developmental, and dietary data were collected at baseline and 6-mo follow-up, along with a blood draw. Plasma choline, betaine, dimethylglycine, trirnethylarnine N-oxide (TMAO), and DHA were measured at both time points using ultrahigh performance liquid chromatography-tandem MS (n = 200 per group). Linear regression analysis was used to determine the difference in plasma choline and related metabolites between groups after 6 mo of intervention. Results: Plasma choline, betaine, dimethylglycine, and DHA concentrations did not differ between groups at 6-mo follow-up. Plasma TMAO was significantly (26%; 95% CI: 7%, 48%) higher in the egg intervention group in a fully adjusted model. Conclusions: Provision of 1 egg/d for 6 mo did not result in increases in plasma choline or related metabolites, except TMAO. This could partially explain the lack of effect on growth and development. Additional interventions are needed to improve choline status, growth, and development in this population. Curr Dev Nutr 2022;6:nzab1 50. Keywords: choline, trirnethylarnine N-oxide, LMIC, growth, development, complementary foods
We assessed the internal validity of the Food Access Survey Tool (FAST) using data from households (
n
= 907) enrolled in an efficacy trial of biofortified maize in rural Zambia. This scale assesses ...food insecurity over a 6-month recall period. A Rasch partial credit model was used to evaluate item performance. Unidimensionality was assessed by principal component analysis, monotonicity was assessed by non-parametric methods, and differential item functioning (DIF) by several characteristics was assessed by cumulative ordinal logistic regression models. One item (frequency of consuming three square meals) did not fit the partial credit model. The remaining eight items fit in a primary single statistical dimension and item category severity increased monotonically with increasing severity of food insecurity. We identified statistically significant DIF in three subgroup comparisons, but effect sizes of total DIF were considered practically insignificant (<2 %). After excluding the item on “square meals,” the FAST serves as an internally valid tool to measure household food insecurity in rural Zambia.
PDF
